Umbilical Catheter Placement and Vascular Access Flashcards

How do you distinguish the umbilical vein from the umbilical arteries when preparing to insert an umbilical venous catheter (UVC)?

Answer: The vein is a single, larger, thin-walled vessel; the two arteries are smaller with thicker, more muscular walls

The umbilical cord contains one vein (single, larger, thin-walled) and two arteries (paired, smaller, thick-walled with more muscular walls). The vein is typically located at the 12 o'clock position.

To what depth should an umbilical venous catheter be inserted for emergency use during neonatal resuscitation?

Answer: Until blood can be freely aspirated — approximately 2–4 cm

For emergency use during delivery room resuscitation, the UVC should be inserted just until blood can be freely aspirated — typically 2–4 cm from the umbilical ring — to allow rapid medication delivery without risk of cardiac complications from deep placement.

What is the primary advantage of intraosseous (IO) access over umbilical venous catheter access during neonatal resuscitation?

Answer: IO access can be established more quickly when UVC placement is difficult or unsuccessful

Intraosseous access can be established very quickly using a standard IO needle and does not require visualization or insertion of a catheter into a small vessel, making it a reliable backup when UVC placement is delayed or unsuccessful.

What complication is most specifically associated with deep or malpositioned UVC placement into the portal venous system?

Answer: Portal vein thrombosis or portal hypertension from infusion of hypertonic solutions

If the UVC tip is positioned in the portal venous system (rather than the IVC-RA junction), infusion of hypertonic solutions (TPN, hypertonic dextrose, sodium bicarbonate) can cause portal vein thrombosis, hepatic injury, and long-term portal hypertension.

Which of the following is a contraindication to umbilical venous catheter insertion?

Answer: Omphalocele, gastroschisis, or omphalitis

Conditions such as omphalocele, gastroschisis, and omphalitis are contraindications to UVC placement, as they involve anomalies or infection of the umbilical region that prevent safe catheter insertion.

After successfully inserting a UVC and confirming blood can be aspirated, what is the next critical step before administering medications?

Answer: Flush the catheter with normal saline to confirm patency and ensure no air is present in the line

Before administering medications, the UVC should be flushed with normal saline to confirm patency, clear any blood from the line, and ensure there are no air bubbles that could cause air embolism.